Public Mental Health System Rates Effective July 1, 2019 ...

Public Mental Health System Rates Effective July 1, 2019

FINAL- revised 6/26/2019

Procedure Code

E&M Code

Service Description

OTHER PROFESSIONAL SERVICES FOR IOP, PHP & CRS

90791

Psychiatric diagnostic evaluation

90791

C&A Psychiatric diagnostic evaluation

90792

Psychiatric diagnostic evaluation with medical services

90792

C&A Psychiatric diagnostic evaluation with medical services

99201

Evaluation and Management, including Rx -Minimal, new patient

99202

Evaluation and Management, including Rx -Straight forward, new patient

99203

Evaluation and Management, including Rx -Low complexity, new patient

99204

Evaluation and Management, including Rx -Moderately complex, new patient

99205

Evaluation and Management, including Rx -Highly complex, new patient

99211

Evaluation and Management, including Rx -Minimal

99212

Evaluation and Management, including Rx -Straight forward

99213

Evaluation and Management, including Rx -Low complexity

99214

Evaluation and Management, including Rx -Moderately complex

99215

Evaluation and Management, including Rx -Highly complex

90832

Individual psychotherapy (30 min) MD Only

90834

Individual psychotherapy (45 min) MD Only

OUTPATIENT/OFFICE PROFESSIONAL SERVICES

90791

Psychiatric diagnostic evaluation

90791

C&A Psychiatric diagnostic evaluation

90792

Psychiatric diagnostic evaluation with medical services

90792

C&A Psychiatric diagnostic evaluation with medical services

90832

Individual psychotherapy (30 min)-Outpatient

90832

C&A Individual psychotherapy (30 min)-Outpatient

90833

Y 30 min Psychotherapy add on

90833

Y C&A 30 min Psychotherapy add on

90834

Individual psychotherapy (45 min)-Outpatient

90834

C&A Individual psychotherapy (45 min)-Outpatient

90836

Y 45 min Psychotherapy add on

90836

Y C&A 45 min Psychotherapy add on

90837

Individual psychotherapy (60 min)

90837

C&A Individual psychotherapy (60 min)

90838

Y 60 min Psychotherapy add on

90838

Y C&A 60 min Psychotherapy add on

90839

Psychotherapy for crisis, first 60 min

90839

C&A Psychotherapy for crisis, first 60 min

90840

Psychotherapy for crisis--additional 30 min

90840

C&A Psychotherapy for crisis-- additional 30 min

90846

Family psychotherapy without patient present

90846

C&A Family psychotherapy without patient present

90847

Family psychotherapy with patient present (45-60 min)

90847

C&A Fam psychoth with patient present (45-60 min)

90847-52

C&A Family psychotherapy with patient present--Abbrev

90849

Multiple family group psychotherapy 45 - 60 minutes

90849

C&A Multiple family group psychotherapy 45 - 60 minutes

90849-52

Multiple family group psychotherapy--Abbrev

90849-52

C&A Multiple family group psychotherapy--Abbrev

H2027

Family psycho-education with consumer present

Family psycho-education without

90853

Group psychotherapy (not multi-family.) 45-60 minutes

90853

C&A Group psychotherapy (not multi-family.) 45-60 minutes.

90853-21

Group psychotherapy prolonged (More than 75 minutes)

90853-21

C&A Group psychotherapy prolonged (More than 75 minutes)

99201

Evaluation and Management, including Rx -Minimal, new patient

99201

C & A Evaluation and Management, including Rx -Minimal, new patient

99202

Evaluation and Management, including Rx -Straight forward, new patient

99202

C & A Evaluation and Management, including Rx -Straight forward, new patient

Default Fee Codes: MYLD1/MYUN1 Provider types: PT20-psych

NOPMD/NOPMU MYLDP/MYUNP

PT20-Nonpsych, 23 without PMH, 80

Psychiatrist non-facility

NonPsych MD, 23 without PMH, 80

MYFC1/ MYFC2 PT20,23 in facility

MYLD2/ MYUN2 PT23 with PMH,24

MYLD3/ MYUN3

PT15

MYLD4/ MYUN4

PT94,CC

MD/CRNP/ PA facility

PMH certified CRNP and APRN

PHD Psych/PsyD

LCSW-C, LCPC, LCADC, LCMFT

MYLD5/ MYUN5 PTMC

OMHC

169.04 169.04 169.04 169.04 46.52 77.20 109.45 166.09 208.77 23.12 45.72 74.83 109.35 146.38 48.79 91.73

MYFC5- (gets all OMHC

&E/M at lesser of rate)

46.52 77.20 109.45 166.09 208.77 23.12 45.72 74.83 109.35 146.38

27.07 50.78 77.13 130.07 169.52 9.18 25.54 51.29 78.53 111.02

120.52 120.52 120.52 120.52 46.52 77.20 109.45 166.09 208.77 23.12 45.72 74.83 109.35 146.38 48.79 91.73

137.64 137.64

120.52 120.52

193.62 216.25 193.62 216.25 46.52 77.20 109.45 166.09 208.77 23.12 45.72 74.83 109.35 146.38 49.77 93.56

169.04 169.04 169.04 169.04 55.78 55.78 55.78 55.78 101.36 101.36 101.36 101.36

94.75 94.75 105.55 105.55 65.37

27.59 27.59

46.52 46.52 77.20 77.20

46.52 46.52 77.20 77.20

27.07 27.07 50.78 50.78

120.52 120.52 120.52 120.52 39.76 39.76 39.76 39.76 72.50 72.50 72.50 72.50

61.18 61.18 74.62 74.62 46.80

28.15 28.15

46.52 46.52 77.20 77.20

137.64 137.64 45.57 45.57 82.58 82.58

79.54 79.54 86.87 86.87 53.23

28.15 28.15

120.52 120.52 39.76 39.76 72.50 72.50

61.18 61.18 74.62 74.62 46.80

28.15 28.15

193.62 216.25 193.62 216.25 56.89 67.29 56.89 67.29 103.39 119.59 103.39 119.59 103.39 119.59 103.39 119.59 113.79 134.56 61.56 70.22 102.48 118.37 107.66 122.35 66.67 45.28 47.72 40.64 43.82 61.18 61.18 44.04 46.49 57.49 57.49 46.52 46.52 77.20 77.20

1

Public Mental Health System Rates Effective July 1, 2019

FINAL- revised 6/26/2019

Procedure Code

E&M Code

Service Description

Default Fee Codes: MYLD1/MYUN1 Provider types: PT20-psych

NOPMD/NOPMU MYLDP/MYUNP

PT20-Nonpsych, 23 without PMH, 80

Psychiatrist non-facility

NonPsych MD, 23 without PMH, 80

MYFC1/ MYFC2 PT20,23 in facility

MYLD2/ MYUN2 PT23 with PMH,24

MYLD3/ MYUN3

PT15

MYLD4/ MYUN4

PT94,CC

MD/CRNP/ PA facility

PMH certified CRNP and APRN

PHD Psych/PsyD

LCSW-C, LCPC, LCADC, LCMFT

MYLD5/ MYUN5 PTMC

OMHC

99203 99203 99204 99204 99205 99205 99211 99211 99212 99212 99213 99213 99214 99214 99215 99215 90875 90876 90889

0929

96101

96102

96130

96131

96136

Evaluation and Management, including Rx -Low complexity, new patient C & A Evaluation and Management, including Rx -Low complexity, new patient Evaluation and Management, including Rx -Moderately complex, new patient C & A Evaluation and Management, including Rx -Moderately complex, new patient Evaluation and Management, including Rx -Highly complex, new patient C & A Evaluation and Management, including Rx -Highly complex, new patient Evaluation and Management, including Rx -Minimal C&A Evaluation and Management, including Rx -Minimal Evaluation and Management, including Rx -Straight forward C&A Evaluation and Management, including Rx -Straight forward Evaluation and Management, including Rx -Low complexity C&A Evaluation and Management, including Rx -Low complexity Evaluation and Management, including Rx -Moderately complex C&A Evaluation and Management, including Rx -Moderately complex Evaluation and Management, including Rx -Highly complex C&A Evaluation and Management, including Rx -Highly complex Indiv psychophysio therapy incl biofdbk (20-30 min) Indiv psychophysio therapy incl biofdbk (45-50 min) Discharge OMS (HCFA) Discharge OMS (UB)

Psych testing, per hour, Ph.D. Lic-Maximum 8 hours per service Terminated 12/31/18

Psychological Testing Computer (Flat rate) Terminnated 12/31/18

Psychological Testing Evaluation services by a Physician or other qualified professional. Treatment planning and Report and Interactive feed back to the patient, family members and caregiver's (first hour)

Psychological Testing, Evaluation and Feedback by Physician or other qualified professional (each additional hour)

Psychological Test administration and scoring by a Physician or other qualified professional (first 30 minutes)

Test administration and scoring by a Physician or other qualified professionals (each additional 30 minutes)

96137

96138 96139 99241 99242 99243 99244 99245

99354

99355

Psychological test administration and scoring by a Technician (first 30 minutes)

Psychological test administration and scoring by a Technician (each additional 30 minutes)

Office Consultation - also used for H&P for PHP (15 Min) Office Consultation - also used for H&P for PHP (30 min) Office Consultation - also used for H&P for PHP (40 min) Office Consultation - also used for H&P for PHP (60 min) Office Consultation - also used for H&P for PHP (80 min) Prolonged phy svc req face-to-face pat contact beyond the usual service

Each additional 30 minutes of a prolonged phy svc

INPATIENT HOSPITAL SERVICES

99221

Initial hospital care (30 min) (MD only)

99221

C&A Initial hospital care (30 min) (MD only)

99222 99222 99223

Initial hospital care (50 min) (MD only) C&A Initial hospital care (50 min) (MD only) Initial hospital care (70 min) (MD only)

99223 99231

C&A Initial hospital care (70 min) (MD only) Subsequent IP care (15 min) (MD only)

99231 99232

C&A Subsequent IP care (15 min) (MD only) Subsequent IP care (25 min) (MD only)

99232 99233

C&A Subsequent IP care (25 min) (MD only) Subsequent IP care (35 min) (MD only)

109.45 109.45 166.09 166.09 208.77 208.77 23.12 23.12 45.72 45.72 74.83 74.83 109.35 109.35 146.38 146.38 55.78 101.36

48.00 89.93 123.01 183.50 223.47

N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

109.45 109.45 166.09 166.09 208.77 208.77 23.12 23.12 45.72 45.72 74.83 74.83 109.35 109.35 146.38 146.38

48.00 89.93 123.01 183.50 223.47

N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

77.13 77.13 130.07 130.07 169.52 169.52 9.18 9.18 25.54 25.54 51.29 51.29 78.53 78.53 111.02 111.02

32.49 68.15 95.31 153.20 189.46

101.86 101.86 136.99 136.99 203.07 203.07 39.30 39.30 72.84 72.84 104.26

109.45 109.45 166.09 166.09 208.77 208.77 23.12 23.12 45.72 45.72 74.83 74.83 109.35 109.35 146.38 146.38 39.76 72.50

48.00 89.93 123.01 183.50 223.47

N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

45.57 82.58

39.76 72.50

109.45 109.45 166.09 166.09 208.77 208.77 23.12 23.12 45.72 45.72 74.83 74.83 109.35 109.35 146.38 146.38 56.89

103.39 24.48

112.57 31.31

128.66

97.78 53.06 49.46 44.18 44.18

112.57 31.31

128.66

97.78 53.06 49.46 44.18 44.18

130.73 99.30

2

Public Mental Health System Rates Effective July 1, 2019

FINAL- revised 6/26/2019

Procedure Code

E&M Code

Service Description

Default Fee Codes: MYLD1/MYUN1 Provider types: PT20-psych

NOPMD/NOPMU MYLDP/MYUNP

PT20-Nonpsych, 23 without PMH, 80

Psychiatrist non-facility

NonPsych MD, 23 without PMH, 80

99233

C&A Subsequent IP care (35 min) (MD only)

99238

Hospital discharge day mgmt (30 min or less) (MD only)

99238

C&A Hospital discharge day mgmt (30 min or less) (MD only)

99239

Hospital discharge day mgmt (>30 min) (MD only)

99239

C&A Hospital discharge day mgmt (>30 min) (MD only)

99251

Initial inpatient consultation (20 min) (MD only) - also used for H&P for Inpatient Non Psych Physician

99252

Initial inpatient consultation (40 min) (MD only) - also used for H&P for Inpatient Non Psych Physician

99253

Initial inpatient consultation (55 min) (MD only) - also used for H&P for Inpatient Non Psych Physician

99254

Initial inpatient consultation (80 min) (MD only) - also used for H&P for Inpatient Non Psych Physician

99255

Initial inpatient consultation (110 min) (MD only) - also used for H&P for Inpatient Non Psych Physician

99281

ER Visit

99282

ER Visit

99283

ER Visit

99284

ER Visit

99285

ER Visit

MISCELLANEOUS 00104

Anesthesia for ECT

90870

ECT single seizure w/ monitoring (Physician only)

36415

Collection of blood by venipuncture

96372

Therapeutic injection

SPECIAL SERVICES

S9480

Intensive OP psych svcs, per diem (clinic model)

S9480

C&A Intensive OP psych svcs, per diem (clinic model)

H0032

Interdisciplinary team tx plng w/patient present

H0046

Therapeutic Nursery

OCCUPATIONAL THERAPY (for recipients under 21 only)

97150

Therapeutic procedure(s) group (2 or more)

97530

Therapeutic activities, direct patient contact, per 15 min.

97535

Self-care/home mgmt trng, per 15 min.

97537

Community/work reintegration trng, direct contact, per 15 min.

THERAPEUTIC BEHAVIORAL SERVICES- Default Fee Code: TWTBS Provider Type: 51/52

N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

107.38 107.51

N/A N/A N/A N/A N/A 48.64 74.43 114.74 166.63 200.43 N/A N/A N/A N/A N/A

MYFC1/ MYFC2 PT20,23 in facility

MYLD2/ MYUN2 PT23 with PMH,24

MYLD3/ MYUN3

PT15

MYLD4/ MYUN4

PT94,CC

MD/CRNP/ PA facility

PMH certified CRNP and APRN

PHD Psych/PsyD

LCSW-C, LCPC, LCADC, LCMFT

104.26

N/A

73.40

N/A

73.40

N/A

108.04

N/A

108.04

N/A

48.64

N/A

74.43

N/A

114.74

N/A

166.63

N/A

200.43

N/A

21.20

N/A

41.35

N/A

61.80

N/A

117.21

N/A

172.65

N/A

20.80 13.46 13.46 13.46

MYLD5/ MYUN5 PTMC OMHC

16.64 16.64 147.44 175.27 94.21 47.97

96150

Initial Assessment & Development of Behavioral Plan for TBS (to be billed in 15 minute increments)

$119.98 ($29.99/ 15 mins)

96151

Reassessment and development of new Behavior Plan for TBS (licensed TBS Providers only) (to be billed in 15 $112.80 ($28.20/

minute increments)

15 mins)

96152

EPSDT Health & behavior intervention (must be a designated provider of Therapeutic Behavioral Services) (to be billed in 15 minute increments)

TRANSCRANIAL MAGNETIC STIMULATION

90867

Therapeutic repetitive TMS Treatment, Initial Treatment Plan

90868

Therapeutic repetitive TMS Treatment, Subsequent Delivery and Management (per session)

90869

Therapeutic repetitive TMS Treatment, Subsequent Re Determination with Delivery and Management

90201-25

Y Evaluation and Management, including Rx -Minimal, new patient

99202-25

Y Evaluation and Management, including Rx -Straight forward, new patient

99203-25

Y Evaluation and Management, including Rx -Low complexity, new patient

99204-25

Y Evaluation and Management, including Rx -Moderately complex, new patient

99205-25

Y Evaluation and Management, including Rx -Highly complex, new patient

99211-25

Y Evaluation and Management, including Rx -Minimal

99212-25

Y Evaluation and Management, including Rx -Straight forward

99213-25

Y Evaluation and Management, including Rx -Low complexity

99214-25

Y Evaluation and Management, including Rx -Moderately complex

99215-25

Y Evaluation and Management, including Rx -Highly complex

$24.52/hr ($6.13/ 15 minutes)

165.11 151.44 413.59 46.52 77.20 109.45 166.09 208.77 23.12 45.72 74.83 109.35 146.38

3

Public Mental Health System Rates Effective July 1, 2019

FINAL- revised 6/26/2019

Procedure Code

E&M Code

Service Description

* Reimbursable using POS 12 for follow-up visits by an OMHC M.D. in a Crisis Bed ** If value of field is 'Y', can charge one E&M Code between 99201 and 99215

Default Fee Codes: MYLD1/MYUN1 Provider types: PT20-psych

NOPMD/NOPMU MYLDP/MYUNP

PT20-Nonpsych, 23 without PMH, 80

Psychiatrist non-facility

NonPsych MD, 23 without PMH, 80

MYFC1/ MYFC2 PT20,23 in facility

MYLD2/ MYUN2 PT23 with PMH,24

MYLD3/ MYUN3

PT15

MYLD4/ MYUN4

PT94,CC

MD/CRNP/ PA facility

PMH certified CRNP and APRN

PHD Psych/PsyD

LCSW-C, LCPC, LCADC, LCMFT

MYLD5/ MYUN5 PTMC

OMHC

4

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download